Bodyworker’s Pathology Review: Folliculitis

As healthcare professionals who regularly make skin contact with their clients, massage therapists must be able to recognize and assess an array of dermatological conditions. Although folliculitis is commonly encountered in the general public, it is also one of the least understood skin anomalies. Despite folliculitis simply being an infection of the hair follicle, it could have half a dozen or more different causes. While one type of folliculitis poses little threat to the client or massage therapist, others may create a formidable transmission risk.

Symptoms of Folliculitis

The signs and symptoms of folliculitis vary, depending on the type of infection. Typically associated with the part of the hair follicle that is infected, there are mild and severe forms of folliculitis. Superficial folliculitis occurs when just the upper part of the follicle is infected, and deep folliculitis affects the entire hair follicle. In general, symptoms include:

Groups of small red bumps around hair follicles
Blisters filled with pus that break open and crust over
Pain, itchiness or tenderness
Large, swollen bump (in cases of deep folliculitis)
Scarring after the infection heals (in cases of deep folliculitis)

Types of Folliculitis

Whether you suspect your client has folliculitis or the person tells you that he/she has already been diagnosed with it, there are many variations of this common skin disorder. Resulting from curly hair or bacterial, viral or fungal infections, a general summary of folliculitis forms include:

Curls

Pseudofolliculitis – Although not technically an infection, this is an inflammation of the hair follicles usually affecting people with wavy or curly hair. When curly hair is shaved, its re-growth can curl back into the skin leading to inflammation and scarring. Also known as razor bumps, pseudofolliculitis is not contagious.

Bacterial

Staphylococcal folliculitis – When hair follicles become infected with Staphylococcus aureus, itchy, white, pus-filled bumps can occur anywhere on the body. When located under the facial hair of men, this dermatological problem is called barber’s itch. Commonly occurring from shaving or a skin injury, it can turn into a boil or carbuncle if the entire hair follicle is affected. Unfortunately, a substantial number of cases of methicillin resistant staphylococcus aureus (MRSA) began as folliculitis. This virulent strain of bacteria is highly resistant to multiple types of antibiotics.
Pseudomonas folliculitis – Also known as hot tub folliculitis, the pseudomonas bacteria thrive in a wide range of environments and can cause a rash of red, round, itchy bumps that will eventually develop into small, pus-filled blisters.
Gram-negative folliculitis – Affecting the entire hair follicle, this type of folliculitis often develops in those on long-term antibiotic treatment for acne due to an overgrowth of gram-negative bacteria. Gram-negative folliculitis can cause severe acne lesions.

Fungal

Tinea barbae – Also developing beneath the facial hair of men, this fungal infection causes tiny, white itchy bumps with surrounding red skin. Untreated, this rash can escalate to pus-filled nodules that eventually form a crust, which may be accompanied by swollen lymph nodes and fever.
Pityrosporum folliculitis – Evidenced by chronic, red, itchy pustules on the back, chest, neck, shoulders, upper arms and face, this yeast-like fungus commonly affects young and middle-aged adults.
Eosinophilic folliculitis – Although experts are unsure of its cause, this type of folliculitis is mostly prevalent in those with HIV. Characterized by recurring, spreading patches of itchy, inflamed, pus-filled sores, primarily on the face and sometimes on the back or upper arms, eosinophilic folliculitis is suspected to involve a yeast-like fungus.

Viral

Herpetic folliculitis – When a herpes simplex viral cold sore is shaved through, it can spread the herpes infection to nearby hair follicles.

For the Massage Therapist

Unless curly hair is the culprit, most of the types of folliculitis are contagious. Unfortunately, many with folliculitis regard it as a minor annoyance and don’t consider it important enough to discuss with their bodyworker. In addition, many cases of folliculitis are mistaken for a simple pimple or acne breakout.

A massage practitioner who makes contact with the affected area could spread the infection to neighboring hair follicles. Besides exacerbating the client’s condition, the therapist and subsequent clients are at an increased risk of exposure to the folliculitis’ causative pathogen. Due to these risks, there are several imperative steps bodyworkers must take to maintain safety:

Avoid the area – Never work on an area with folliculitis, whether it is a suspected or confirmed case. If possible, use gloves and a bandage to cover the problem area and request the client do so prior to future sessions.
Launder carefully – Make certain that any linen in contact with a client harboring folliculitis is separated from other linens and is properly laundered with hot, soapy water and bleach.
Protect your hands – If you do not use gloves, keep liquid bandage on hand to make sure any cuts or nicks on your hands are completely sealed. In addition, take extra care when washing your hands before and after clients.

When it comes to breaches in the skin’s integrity, bodyworkers must be prepared to protect their client, themselves and subsequent visitors. By realizing that what could be mistaken for a pimple could actually be a bacterial, viral or fungal infection, massage therapists will increase their attentiveness to the presence of folliculitis. As long as bodyworkers avoid the affected area, are careful with dirty linens and protect their hands, they needn’t worry endlessly about the pathogens lurking in their client’s hair follicles.